1. Laryngeal disorders DR MAHIPAL REDDY

2. Laryngeal disorders BY/DR K SUBHASH.,DR SRIDHAR,DR SREEKANTH AND ALL ENT SURGEONS OF IMA

4. Pretest T or F 1. Reurrent laryngeal nerve pure motor fiber larynx 3. Acute laryngitis 4. epiglottitis laryngospasm 5. Thumb’s sign croup 6. Vocal nodule unilateral mass 7. Vocal granuloma intubation 8. Laryngeal trauma intubation 9. Most common symptom ของ true vocal carcinoma neck node enlargement 10. acid reflux

5. Laryngeal disorders ผศ . นพ . ยงยุทธ วศินวงศ์ ภาควิชาจักษุ โสต นาสิกลาริงซ์วิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ

7. 1. Anatomy Framework Muscles – intrinsic - extrinsic Innervation Vessels

8. Framework

11. Muscles Intrinsic – adductors ; thyroarytenoid (true vocal cord:TVC), cricoarytenoid, interarytenoid - abductor ; post cricoarytenoid Extrinsic - cricothyroid

14. Innervation Inferior RLN motor - all muscles except.. sensory- below TVC Superior RLN motor – cricothyroid muscle sensory – above TVC

15. Blood supply Arterial sup. laryngeal artery inf. Laryngeal artery Venous sup. & inf. Thyroid veins

17. Protection inspiration phonation

18. 1. Inflammation - Acute & chronic laryngitis , c roup, epiglottitis, ulcer, 2. Tumor - benign, nodule, polyp, granuloma - malignancy 3. Trauma - penetrating injury - blunt injury - iatrogenic 4. Congenital - cord paralysis, Laryngeal web, subglottic stenosis 5. Miscellaneous - laryngopharyngeal reflux (LPR) disease Laryngeal disorders

19. Common laryngeal disorders 1. Acute laryngitis 2. Croup 3. Epiglottitis 4. Vocal nodule 5. Vocal polyp 6. Vocal granuloma 7. Laryngeal carcinoma 8. Laryngeal trauma 9. Laryngopharyngeal reflux (LPR)

20. Acute laryngitis Pathogen - adenovirus, influenza Morexella catarrharis Hemophilus influenza Streptococcus pneumoniae Symptoms - hoarseness cough, +/- fever, malaise Sign - TVC swelling

22. Acute laryngitis Treatment - voice rest - mucolytic, anticold +/- antibiotic Symptoms > 2 week, recurrent DDx - chronic laryngitis

23. Croup (acute laryngotracheobronchitis) - Severe respiratory infection - 6 months-2 yrs. Pathogen - parainfluenza*influenza, adenovirus - follow by bacterial esp. H. influenza Symptoms - early URI symptoms - 2-3 days - barking cough, stridor - exhausted, lying down

24. Croup (acute laryngotracheobronchitis) Diagnosis - symptoms & signs - flexible scope - x-ray norrowing of subglottis “ Pencil’s sign”

25. Pencil’s sign Normal

26. Croup (acute laryngotracheobronchitis) Treatment - early detection - observe, admit - humidification, hydration, O2 - antibiotic (penicillin) severe - steroid - intubation

27. Epiglottitis - infection of supraglottis >> epiglottis - 2-10 yr., adult Pathogen - H. influenza type B Symptoms - early URI symptoms - children > change very fast 6-12 hr. - high fever, pain in throat - นั่ง โน้มตัวมาข้างหน้า *

28. Epiglottitis Signs - epiglottis > swelling, inflam - ** laryngospasm เมื่อกดลิ้น - fiberoptic X-ray - “Thumb’s sign”

29. Epiglottitis Treatment - admit, closed monitoring - broad spectrum penicillin - hydration, humidification - +/- steriod - prepare for intubation

30. Vocal cord nodule - vocal abuse, over-used - children, adult - fibrous formation Symptoms - hoarseness Sign - nodule TVC > bilateral > anterior 1/3

31. Nodule Treatment - voice rest - speech therapy - failed, recurrent > surgery

32. Vocal polyp - vocal abuse - Reinke edema > capsule surrounding (polyp) Symptoms - hoarseness > 2 wk Sign - ant 1/3 TVC, unilateral Treatment - surgery - follow by speech therapy

33. Reinke’s edema Vocal polyp Both polyp, nodule

34. Vocal granuloma inflammation > ulcer > granuloma etiology - intubation - gastroesophageal reflux - partial laryngectomy Symptoms - hoarseness 2-3 wk after extubation

35. Vocal granuloma Sign - arytenoid, unilateral Treatment - surgery - follow by speech therapy - Rx acid reflux

36. Carcinoma Chronic irritation - smoking, alcohol, pollution, acid reflux Pathology - epithelial hyperplasia > dysplasia > carcinoma insitu > carcinoma

37. Carcinoma Symptoms > 2-3 weeks - glottis > hoarseness - supraglottis > dysphagia - subglottis > airway problems others - referred otalgia, chronic cough, hemoptysis, lymphadenopathy, wt. loss

38. Carcinoma Diagnosis - biopsy ; indirect or direct laryngoscopy - extension ; CT, MRI - metastasis ; CXR, LFT Treatment - depends on staging TNM - early > surgery or RT alone - stage 3, 4 > combined surgery, RT, ChemoRx

39. Laryngeal trauma Most common -Car accident Others - athlete, penetrating, gun-short wound S&S >> location, severity - stridor, bleeding, emphysema, hemoptysis, dysphagia, crepitation - severe case > coma

40. Laryngeal trauma

41. Laryngopharyngeal reflux (LPR)

42. Laryngopharyngeal reflux (LPR) Stomach acid > reflux to esophagus + others = gastroesophageal reflux (GER) reflux up to larynx = LPR Etiology - relax sphincter, acid production food ; chocolate, spicy, cola, alcohol, drugs ; theophylin l ife-style ; eat late at night

43. Laryngopharyngeal reflux (LPR) Symptoms - feel lump in the throat, chronic cough, regurgitation, heartburn Signs - arytenoid edema, TVC sweling granuloma, ulcer >>> carcinoma

44. Laryngopharyngeal reflux (LPR) Treatment - Lifestyle modification diet, stress, avoid eating before bedtime - medication protonpump inhibitor, H2 antagonist, antacid + prokinetic - surgery